Patients’ views on stroke prevention for atrial fibrillation after an intracerebral haemorrhage: a qualitative study

Abstract

Aim (i) To explore the attitudes of patients with atrial fibrillation (AF) towards oral anti-coagulation (OAC) for stroke prevention post-intracerebral haemorrhage (ICH) and (ii) to explore factors that influence patients’ decision-making process for stroke prevention. Methods Patients with documented diagnosis of AF and history of a non-traumatic ICH, who were eligible for long-term OAC were and results recruited from eight hospitals in England, using purposive sampling. Data were collected using semi-structured interviews and analysed using Framework analysis. Twelve patients (mean (SD) age 76.2 (6.6) years; 9 men) were recruited. Patients’ main priority was to maintain an acceptable quality of life (QoL), reflected by the main theme ‘Living my life as normal’. When deciding to accept or decline OAC for stroke prevention, patients were influenced by the following: (i) The individual, meaning factors relating to individuals’ personal attitudes towards health and healthcare, (ii) Medical factors, encompassing factors relating to patients’ trust in medical expertise and patients’ information-seeking behaviours, and (iii) Social factors, highlighting the influence of patients’ social support network on patients’ decision-making. Conclusion Patients’ decision-making for stroke prevention for AF post-ICH was influenced by individual, medical, and social factors. At the heart of patients’, decision-making were concerns with maintaining an acceptable QoL. The study findings help nurses and other healthcare professionals to better understand what matters to patients who are eligible for stroke prevention for AF post-ICH, thus promoting more effective shared decision making.